Stop-Loss Basics
What is stop-loss insurance designed to protect against?
High-cost claims in self-funded health plans
A claim exceeds $75,000 and triggers this type of coverage
Specific stop-loss
Aggregate stop-loss kicks in when total claims exceed this
Aggregate attachment point/deductible
The period during which claims must be incurred
Incurred period
Choosing a higher deductible typically results in this
Lower premium
This type of stop-loss covers individual large claims
Specific stop-loss
The threshold for an individual claim before reimbursement begins
Specific deductible
The period during which claims must be paid to be eligible
(JVV - can you talk about def. of paid?)
Paid period
This partner helps administer claims and coordinate stop-loss
TPA
This type of stop-loss protects against total plan costs exceeding expectations
Aggregate stop-loss
This term describes the maximum reimbursement per individual claim
Specific limit
A "12/12" contract means this
12 months incurred/ 12 months paid
This strategy spreads risk across multiple employers
Captive
The dollar amount at which stop-loss coverage begins is called this
Deductible/Attachment point
Lasers are used to adjust this for high-risk individuals
Specific deductible
A "12/15" contract allows this extra time
3 additional months to pay claims
This party typically purchases stop-loss insurance in a self-funded plan
The employer/plan sponsor
This provision allows claims paid after termination to still be reimbursed
Run-out provision